Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.
Department of HPB and Upper Gastrointestinal Surgery, Westmead Hospital, Westmead, New South Wales, Australia.
ANZ J Surg. 2023 Nov;93(11):2648-2654. doi: 10.1111/ans.18714. Epub 2023 Sep 29.
Despite its proposed benefits, laparoscopic pancreaticoduodenectomy (LPD) has not been widely adopted due to its technical complexity and steep learning curve. The aim of this study was to report a single surgeon's experience in the stepwise implementation of LPD and evolution of technique over a nine-year period in a moderate-high volume unit.
Carefully selected patients underwent LPD initially by hybrid approach (laparoscopic resection and open reconstruction), which evolved into a total LPD (laparoscopic resection and reconstruction). Data was prospectively collected to include patient characteristics, intraoperative data, evolution of technique and postoperative outcomes.
A total of 25 patients underwent hybrid LPD (HLPD) and 20 patients underwent total LPD (TLPD). There was no 90-day mortality. Three patients developed a postoperative pancreatic fistula (POPF), all of which occurred in patients undergoing HLPD. There was no POPF in 20 consecutive TLPD. There was no evidence of anastomotic strictures in the hepaticojejunostomy in patients undergoing TLPD at long term follow up.
A gradual and cautious progression from HLPD to TLPD is essential to ensure safe implementation into a unit. LPD should only be considered in carefully selected patients, with outcomes subjected to regular and rigorous independent audit.
尽管腹腔镜胰十二指肠切除术（LPD）具有诸多益处，但由于其技术复杂性和陡峭的学习曲线，尚未得到广泛应用。本研究旨在报告一位外科医生在中高容量单位中，经过九年时间，分阶段实施 LPD 并不断发展技术的经验。
精心选择的患者最初通过杂交方法（腹腔镜切除和开放重建）接受 LPD，然后逐渐发展为全腹腔镜胰十二指肠切除术（TLPD，laparoscopic resection and reconstruction）。前瞻性收集数据，包括患者特征、术中数据、技术演变和术后结果。
共有 25 例患者接受了杂交 LPD（HLPD），20 例患者接受了全腹腔镜胰十二指肠切除术（TLPD）。没有 90 天死亡率。3 例患者发生术后胰瘘（POPF），均发生在 HLPD 患者中。20 例连续 TLPD 患者无一例发生 POPF。在长期随访中，TLPD 患者的肝肠吻合口未见吻合口狭窄的证据。
从 HLPD 到 TLPD 的逐步、谨慎进展对于确保在单位内安全实施至关重要。LPD 应仅在精心选择的患者中考虑，其结果应接受定期和严格的独立审查。
